The initiative, which went live at the start of 2025, is being rolled out alongside 11 providers across the state, serving around 17,000 patients. The project is backed by the California Quality Collaborative and the Integrated Healthcare Association, with the goal of tackling painpoints around primary care reimbursement, health outcomes, and disparities.
“What we’re doing here with this demonstration project is revolutionary. It’s multi-plan alignment and we’re all rowing in the same direction,” Todd May, MD, vice president and medical director at Health Net, told Becker’s. “The practices know what’s expected of them, and this is amplifying our impact on producing high-quality, high-value results. Health plans, together with CQC and IHA, have been involved in the design of the payment models, developing the metrics, creating the implementation plan, and now assessing outcomes.”
Major health insurers are usually in competition with one another. By aligning payment systems, the three companies will use the single model to reward physicians for delivering high-quality care, rather than just the number of services they provide. The new model will specifically reward metrics that show better management of chronic diseases like diabetes and high blood pressure, as well as meeting preventive care goals related to immunizations and cancer screenings.
“We’re calling this a demonstration project rather than a pilot for a reason. Pilots are initial attempts to test out an idea, but this project is based on science and experience,” Dr. May said. “We know that advanced primary care works, so we’re moving ahead beyond a test phase. So far, we’ve learned that health plans can indeed come together collaboratively, sit in the same room, align around key innovations, and engage targeted practices in committing to transformation.”
A key piece of the initiative is the inclusion of small, independent practices, which often don’t have the resources to make these kinds of changes on their own. Although healthcare consolidation has ramped up in recent years, independent practices still make up a significant portion of primary care providers in California.
The insurers will provide a shared platform to the practices so that they can access a comprehensive view of patient information, regardless of which insurer provides their coverage. Dr. May said the platform will help identify disparities in care and can be broken down by factors such as race, ethnicity, and language.
“The goal is visibility — seeing where care gaps exist — and then taking action,” he said. “By reaching out to underserved members and delivering services, we can promote health equity. Many of these members have fewer resources and fewer opportunities to access care on their own, so by bringing them in or delivering services to them, we can improve health outcomes for those most in need.”
Eventually, the hope is that the new model can be expanded beyond California, with more health plans getting involved.
“Watch this and pay attention to what we’re doing here,” Dr. May said. “We’re optimistic about the positive results we’re hoping to demonstrate. It may seem counterintuitive for competitors to collaborate, but it makes sense. We’re not sharing proprietary information or violating competition laws. We’re focused on improving the health outcomes of Californians, and everyone can get behind that.”
Participating providers are here. A full model guide is available here.
